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BackgroundTo determine the frequency of, and factors associated with, death in hospital following ICU discharge to the ward.MethodsThe Large observational study to UNderstand the Global impact of Severe Acute respiratory FailurE study was an international, multicenter, prospective cohort study of patients with severe respiratory failure, conducted across 459 ICUs from 50 countries globally. This study aimed to understand the frequency and factors associated with death in hospital in patients who survived their ICU stay. We examined outcomes in the subpopulation discharged with no limitations of life sustaining treatments ('treatment limitations'), and the subpopulations with treatment limitations.Results2186 (94%) patients with no treatment limitations discharged from ICU survived, while 142 (6%) died in hospital. 118 (61%) of patients with treatment limitations survived while 77 (39%) patients died in hospital. Patients without treatment limitations that died in hospital after ICU discharge were older, more likely to have COPD, immunocompromise or chronic renal failure, less likely to have trauma as a risk factor for ARDS. Patients that died post ICU discharge were less likely to receive neuromuscular blockade, or to receive any adjunctive measure, and had a higher pre- ICU discharge non-pulmonary SOFA score. A similar pattern was seen in patients with treatment limitations that died in hospital following ICU discharge.ConclusionsA significant proportion of patients die in hospital following discharge from ICU, with higher mortality in patients with limitations of life-sustaining treatments in place. Non-survivors had higher systemic illness severity scores at ICU discharge than survivors.Trial registrationClinicalTrials.gov NCT02010073 .

Original publication

DOI

10.1186/s13054-021-03465-0

Type

Journal

Critical care (London, England)

Publication Date

13/04/2021

Volume

25

Addresses

Value-Based Health Care Unit, IRCCS MultiMedica, Sesto San Giovanni, Milan, Italy.

Keywords

LUNG SAFE Investigators, ESICM Trials Group, Humans, Respiratory Insufficiency, Patient Discharge, Mortality, Logistic Models, Risk Factors, Prospective Studies, Adult, Aged, Middle Aged, Intensive Care Units, Female, Male, Kaplan-Meier Estimate